constipated. There is frequently albuminuria, and
occasionally nocturnal delirium. A moderate degree of leucocytosis
(15,000 to 20,000) is usually present.

Around the seat of inoculation a diffuse red patch forms, varying in hue
from a bright scarlet to a dull brick-red. The edges are slightly raised
above the level of the surrounding skin, as may readily be recognised by
gently stroking the part from the healthy towards the affected area. The
skin is smooth, tense, and glossy, and presents here and there blisters
filled with serous fluid. The local temperature is raised, and the part
is the seat of a burning sensation and is tender to the touch, the most
tender area being the actively spreading zone which lies about half an
inch beyond the red margin.

[Illustration: FIG. 25.--Chart of Erysipelas occurring in a wound.]

The disease tends to spread spasmodically and irregularly, and the
direction and extent of its progress may be recognised by mapping out
the peripheral zone of tenderness. Red streaks appear along the lines of
the superficial lymph vessels, and the deep lymphatics may sometimes be
palpated as firm, tender cords. The neighbouring glands, also, are
generally enlarged and tender.

The disease lasts for from two or three days to as many weeks, and
relapses are frequent. Spontaneous resolution usually takes place, but
the disease may prove fatal from absorption of toxins, involvement of
the brain or meninges, or from general streptococcal infection.

#Complications.#--_Diffuse suppurative cellulitis_ is the most serious
local complication, and results from a mixed infection with other
pyogenic bacteria. Small _localised superficial abscesses_ may form
during the convalescent stage. They are doubtless due to the action of
skin bacteria, which attack the tissues devitalised by the erysipelas. A
persistent form of _oedema_ sometimes remains after recurrent attacks of
erysipelas, especially when they affect the face or the lower extremity,
a condition which is referred to with elephantiasis.

#Treatment.#--The first indication is to endeavour to arrest the spread
of the process. We have found that by painting with linimentum iodi, a
ring half an inch broad, about an inch in front of the peripheral tender
zone--not the red margin--an artificial leucocytosis is produced, and
the advancing streptococci are thereby arrested. Several coats of the
iodine are applied, one after the other, and this is repeated dai